10D2158938 CLIA NUMBER - PROSCAN NCH IMAGING, LLC

Laboratory Demographics

  • CLIA Code: 10D2158938
  • Facility Name: PROSCAN NCH IMAGING, LLC
  • Facility Address: 24040 S TAMIAMI TRAIL ATTN RADIOLOGY
    BONITA SPRINGS, FL
    ZIP 34134
  • Facility Phone: 239 572-8649
  • Facility Type: Other - OUT PATIENT IMAGING CENTE
  • Facility Type: Waiver
  • Lab Director: GILBERT H. MAULSBY
  • NPI Number: 1750972493
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 10D2158938
LAB Type Other - OUT PATIENT IMAGING CENTE
Facility Name PROSCAN NCH IMAGING, LLC
Street 24040 S TAMIAMI TRAIL ATTN RADIOLOGY
City BONITA SPRINGS
State FL
ZIP 34134
Phone 239 572-8649
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Other - OUT PATIENT IMAGING CENTE
Lab Director GILBERT H. MAULSBY

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This page was last updated on: 9/29/2025